Surgical method for tissue removal

ABSTRACT

A method for removal of tissue from a patient utilizing an electrosurgical instrument. The electrosurgical instrument includes a handle portion having a pair of end effectors configured to remove tissue, connected to and supported by the handle portion for relative movement generally toward one another. One of the end effectors includes a conductive cutting portion that is configured to receive electrical energy from an electrical energy source. The other of the end effectors includes an opposing portion. The opposing portion is brought into a position generally opposing the conductive cutting portion during relative movement of the end effectors toward one another. When electrical energy is conducted through the conductive cutting portion, removal and cauterization of the tissue from the patient is facilitated.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.13/660,552, filed on Oct. 25, 2102, which claims priority to U.S.Provisional Application No. 61/622,658, filed on Apr. 11, 2012, and toU.S. Provisional Application No. 61/683,648 filed on Aug. 15, 2012, theentire contents of all of which are hereby incorporated by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention generally relates to a surgical instrument andmethod for tissue removal. More specifically, the present inventionrelates to a surgical instrument and method for performing the removalof either palatine and pharyngeal types of tonsils, and even moreparticularly, the latter type of tonsils, which is commonly referred toas adenoids.

2. Description of Related Technology

As seen in FIG. 1, tonsils (T) and adenoids (A) are a masses of lymphoidtissue generally found in the oral and nasal cavities (C_(o), C_(n))respectively. The tonsils are a set of tissue located on both sides atthe back of the throat. Adenoids, on the other hand, comprise a singleclump of tissue that is not directly visible from outside the mouth. Theadenoids are located rearward of the nasal cavity and above the softpalate, generally where the nasal cavity merges with the throat.

Both tonsils and adenoids are subject to infection, particularly inchildren. When infected, the enlarged tissue may impair breathingthrough the nose, cause snoring, cause retention of fluid (and,therefore, infection of the ears (caused by the adenoids)), causeaccumulation of nasal secretions (and, therefore, sinus infections(caused by the adenoids), and cause difficulty in swallowing andbreathing (caused by the tonsils). Since neither tissue has beenobserved to serve an immunological or other function in adulthood, wheninfections are common and recurring, one preferred treatment is thesurgical removal of the tissue, which is called either an adenoidectomyor a tonsillectomy.

Common methods for removing the adenoids and tonsils include utilizationof a curette, forceps or an electrocautery device. A curette is asurgical instrument having a spoon or otherwise shaped end that is usedto scrape and remove the desired tissue. With an electrocautery device,radio-frequency energy is applied to tissue, heating the water in thelocal tissues, thereby weakening the tissue, allowing mechanicalscraping removal and simultaneous cauterizing of removal site to reduceor stop bleeding.

Of the two procedures, some physicians prefer electrocautery since itminimizes the bleeding associated with removal of the tissue. However,current instruments for electrocautery are not specifically designed forrapid removal of either the tonsils or the adenoids.

SUMMARY

In view of the above limitations and drawbacks, in one aspect, anelectrosurgical instrument for removal of tissue from a patient isprovided, the electrosurgical instrument comprising: a handle portion; apair of end effectors configured to remove tissue, the end effectorsbeing connected to and supported by the handle portion for relativemovement generally toward one another; one of the end effectorsincluding a conductive cutting portion, the conductive cutting portionbeing configured to receive electrical energy from an electrical energysource; the other of the end effectors including an opposing portion,the opposing portion being brought into a position generally opposingthe conductive cutting portion during relative movement of the endeffectors toward one another; and wherein when electrical energy isconducted through the conductive cutting portion facilitating removaland cauterization of the tissue from the patient.

In another aspect, the opposing portion is non-conductive, theelectrosurgical instrument being a unipolar electrosurgical instrument.

In a further aspect, the end effector includes a curved arm portion anda tip, the conductive cutting portion being provided along at least aportion of the tip.

In an additional aspect, the tip portion is enlarged relative to the armportion.

In still another aspect, the tip portion is ovoid or ring shape.

In yet a further aspect, at least part of the handle portion iselectrically conductive and configured to electrically connect the endeffector to the electrical energy source.

In an additional aspect, the opposing portion is conductive andconfigured to be electrically coupled to the electrical energy source,the electrosurgical instrument being a bipolar electrosurgicalinstrument.

In another aspect, the conductive cutting portion and the opposingportion are opposite one another so as to bear against each other whenbrought fully together.

In still a further aspect, the conductive cutting portion and theopposing portion have complementary shapes to one another.

In yet an additional aspect, the end effectors are removably connectedto the handle portion.

In another aspect, the end effectors are fixedly connected to the handleportion.

In an additional aspect, the handle portion is connected to the endeffectors by pivotably connected lever members providing theelectrosurgical instrument with a scissors construction.

In still another aspect, one of the lever members is electricallyconductive and electrically connected to the conductive cutting portion.

In a further aspect, the conductive cutting portion includes a bladehaving a sharpened edge.

In another aspect, the conductive cutting portion further defines anexposed width portion, the exposed width portion extending in adirection away from the sharpened edge.

In an additional aspect, the opposing portion defines an edge cooperateswith the conductive cutting portion to facilitate removal of tissue.

In yet a further aspect, at least part of the electrosurgical instrumentis disposable.

In another aspect, the end effectors further include generally opposingclamping portions, the clamping portions being configured to clamp andsecure dissected tissue.

In a further aspect, the clamping portions are adjacent to theconductive cutting portion and the opposing portion.

In an additional aspect, an electrosurgical instrument for removal oftissue from a patient is provided, the electrosurgical instrumentcomprising: a pair of opposing end effectors, at least one of the endeffectors including a exposed electrode, at least one of the endeffectors including a cutting portion and the other of the end effectorsincluding an opposing portion opposing the cutting portion, each of theend effectors including opposed tissue retention portions; a handlecoupled to the end effectors; an actuator associated with the handle andconfigured to cause relative movement of the end effectors toward eachother whereby the tissue is constrained between the tissue retentionportions, the opposing portion and the cutting portion being configuredto engage tissue constrained between the tissue retention portions; theelectrode being directly or indirectly electrically connected to asource of electrosurgical energy; and whereby when the tissue isconstrained between the tissue retention portions and electrosurgicalenergy is applied to the electrode, at least a portion of the tissue isdissected by the cutting and opposing portions, cauterized by theelectrode and held between the tissue retention portions for removalafter being dissected.

In still another aspect, the end effectors are removably or fixedlyconnected to the handle.

In yet a further aspect, the conductive portion is unitarily formed withthe cutting portion.

In an additional aspect, the cutting portion and opposing portion definecongruent surfaces.

In yet another aspect, the congruent surfaces are aligned with eachother when the cutting portion and opposing portion are moved towardeach other by the actuator.

In a further aspect, a method of removing tissue from a patientutilizing an electrosurgical instrument is provided, the methodcomprising: providing an electrosurgical instrument having a pair ofopposing end effectors, at least one of the end effectors including aconductive cutting portion and the other of the end effectors includingan opposing portion, the end effectors each further including opposingtissue retention portions; positioning the conductive cutting portion onone lateral side of the tissue to be removed and positioning theopposing portion on an opposing lateral side of the tissue to beremoved; positioning the tissue retention portions of each end effectoron opposing lateral sides of the tissue to be removed; causing relativemovement of the end effectors toward each other; constraining the tissueto be removed between the tissue retention portions; providingelectrosurgical energy to the conductive cutting portion; passingelectrosurgical energy through the tissue to be removed; dissecting thetissue through a combination of the electrosurgical energy passingthrough the tissue and the conducting cutting portion; cauterizing thetissue through a combination of the electrosurgical energy passingthrough the tissue and the conducting cutting portion; performing thedissecting and cauterizing steps while continuing to constrain thetissue between the tissue retention portions; and removing the dissectedtissue from the patient while continuing to constrain the tissue betweenthe tissue retention portions.

In still an additional aspect, the step of dissecting the tissueutilizes a sharpened edge formed on the conducting cutting portion.

In another aspect, the step of cauterizing the tissue utilizes a widthof the conductive cutting portion extending in a direction away from thesharpened edge.

In a further aspect, the step of contacting an electrode with thepatient at a location remote from the site of the tissue to be removed.

In yet an additional aspect, the positioning steps position tonsiltissue between the end effectors.

In another aspect, the tonsil tissue is pharyngeal tonsil tissue.

Further objects, features and advantages of this invention will becomereadily apparent to persons skilled in the art after a review of thefollowing description, with reference to the drawings and claims thatare appended to and form a part of this specification.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagrammatic illustration of the oral and nasal cavities ofa person showing the relative locations of the tonsils and adenoidstherein;

FIGS. 2 a-2 c are perspective views of cautery forceps embodying theprinciples of the present invention;

FIG. 3 is a perspective, enlarged view of the end of the cautery forcepsseen in FIGS. 2 a-2 c;

FIG. 4 is an exploded perspective view an end effector as utilized inwith the cautery forceps seen in FIG. 2 a-2 c;

FIG. 5 is a diagrammatic illustration of the end effectors of thecautery forceps positioned at the interface of the oral and nasalcavities and adjacent to the soft palate and adenoids as may bepositioned during use;

FIG. 6 is a perspective illustration of an alternative embodiment ofcautery forceps embodying the principles of the present invention;

FIG. 7 is a perspective illustration of a further embodiment of cauteryforceps embodying the principles of the present invention;

FIG. 8 is an inverted, perspective illustration of an additionalembodiment of cautery forceps embodying the principles of the presentinvention;

FIG. 9 is a perspective illustration of the embodiment of FIG. 8 showingthe underlying frame members of the construction, also in an invertedposition;

FIG. 10 is an enlarged view of the frame members seen in FIG. 9; and

FIG. 11 is an enlarged view of the cautery forceps of FIG. 8, turnedover and seen from the opposing side thereof.

DETAILED DESCRIPTION

The present invention provides an electrosurgical instrument for removalof tissue. While those skilled in the art will appreciate thatinstruments incorporating the principles of the present invention aresuitable for use in removing multiple types of tissue, described hereinare instruments for removal of tonsil tissue, such as the palatinetonsils (commonly referred to as just the “tonsils”) and, moreparticularly, pharyngeal tonsils (commonly referred to as the“adenoids”). For simplicity, the discussion that follows simply refersto the removal of the adenoids.

Overview

Referring now to FIGS. 2 a-2 c and 3, illustrated therein, anddesignated at 10, is an electrosurgical instrument in accordance withthe principles of the present invention. As seen in these figures, theelectrosurgical instrument 10 may generally be described as being in theshape of a pair of forceps. Unlike common forceps, however, the surgicalinstrument 10, hereinafter referred to as cautery forceps 10, includes apair of handles 11 to which are mounted a pair of removable endeffectors 12, 13. Additionally, the cautery forceps 10 include a means14, such as a power cord, by which at least one of the end effectors 12,13 can be connected to a suitable electrical power source.

Power Source

Preferably, the power source is an available source of power located inthe room where the cautery forceps 10 are to be used. As such, the powersource includes the required componentry needed to provide the propervoltage, current and frequency for electrocautery surgery. Generally,electrocautery requires a frequency in the radio frequency range, above100 KHz and up to 5 MHz. This power source itself can be provided as anintegrated system such that the power cable 14 is merely plugged into anoutlet (not show) in the room. Alternately, the power source can beprovided as a stand-alone power system located in the operating room oras a battery incorporated into the electrosurgical instrument.

Unipolar and Bipolar

The cautery forceps 10 according to the present invention are preferablyunipolar (also known as monopolar) in their construction. In such aconstruction, the cautery forceps 10 themselves include a singleelectrode in one of the end effectors 12, which is further discussedbelow. During use, current flows from the electrode, through thepatient, and to a return electrode affixed elsewhere on the patient'sbody.

In an alternative embodiment, the cautery forceps 10 are of a bipolarconstruction. In a bipolar construction, a second electrode is providedon the other end effector 13. During use of the bipolar cautery forceps10, electrical current passes primarily from one electrode on one endeffector to the second electrode on the other end effector. The currentthus passes primarily through a localized portion of the affected tissueof the patient, which is located between the electrodes, and in contrastto flowing through the body of the patient to a remotely locatedelectrode in the unipolar construction.

Handles

The handles 13 of the cautery forceps 10 in the illustrated embodimentare provided in conjunction with two lever members 24, 26 that arearranged such that the cautery forceps 10 operate in a traditional,scissors-like construction. In such a construction, the two levermembers 24, 26 cross one another at a central pivot joint 28, whichincludes pivot axle. The handles 11 may be provided with finger rings orgrips 30, 32 at one end, while the lever members 24, 26 terminate inmounting tips 34, 36 at the opposing end. By bringing the finger grips30, 32 together, the opposing mounting tips 34, 36 are likewise broughttoward one another.

Preferably, the lever members 24, 26 are solidly constructed of a metalmaterial, such as surgical grade stainless steel, aluminum or anotherconductive material. Constructed in this manner, at least one of thelever members 24, 26 can operate as a conductor to transmit currentthrough the cautery forceps 10, as further discussed below. The pivotjoint 28 between the two lever members 24, 26 is constructed such thatthe two members 24, 26 are electrically isolated from one another by wayof an insulating bushing (not shown) or other feature. Failure toelectrically isolate the two lever members 24, 26 would result in theshorting of the electrical circuit and would render the end effectors12, 13, which are themselves further discussed below, as inoperative incertain respects.

The finger rings 30, 32 of the handles 11 may be formed as a traditionalringed portion so as to facilitate the grasping of the cautery forceps10 and the manipulation thereof by the surgeon. Alternatively, they maybe provided with other shapes.

The lever members 24, 26 are electrically isolated from the surgeon bycovering the lever members 24, 26 with an insulative material. Variousmeans by which the lever members 24, 26 may be covered are envisionedand include dip coating or spray coating with rubber or plastisol orovermolding of the lever members 24, 26 with a polymer material, such aspolycarbonate, ABS, HDPE, acrylic, or other material having theappropriate insulative characteristics. The material covering the levermembers 24, 26 should also facilitate grasping of the handles 22 andminimize potential slipping of the cautery forceps 10 when held and inuse by the surgeon.

The previously mentioned power cable 14 is configured at one end with anelectrical connector 16, suitable for making the required electricalconnection with the electrical power source. The opposing end of thepower cable 14 is also provided with an electrical connector 18. Thislatter electrical connected 18 matingly engages a receptacle terminal 20associated with one of the lever members 24 of the handles 11. As such,the connectors 16, 18 on each end of the power cable 14 are preferablyone of a plug or receptacle terminal, such as a banana-plug or amultiple pronged RF surgical plug, suitable for a robust connection andelectrical power supply.

In the illustrated embodiment, the terminal 20 is formed adjacent to thehand grip 30 of the lever member 24. While the terminal 20 isillustrated as being located adjacent to the ring portion of the handgrip 30, generally on the inward side thereof, it will be understoodthat the terminal 20 could be located elsewhere on the hand grip 30 orthe lever member 24. Additionally, the terminal 22 may alternatively beattached to the lever member 24 via a suitable connection or it may beinsert molded during the formation of the lever member 24.

End Effectors

The end effectors 12, 13 are seen in FIGS. 2 a-5 and each has the samegeneral construction, being principally composed of an arm portion 40and a tip portion 42, with the tip portion 42 being formed at a distalend of the arm portion 40. The arm portion 40 is curved along its lengthand the tip portion 42 is formed generally in an ovoid ring shape. Thecurvature and length of the arm portion 40 is such that it facilitatesthe positioning of the tip portion 42 in the vicinity of the adenoids,as seen in FIG. 5, so as to enhance the ease with which the adenoids areaccessed and the ease with which the cautery forceps 10 are manipulatedduring the surgical procedure. The length and curvature of the armportions 40 may be provided in a variety of configurations, includinghaving straight portions, so as to accommodate differing patientanatomies and the preferences of the surgeons. Generally, however, thecurvature of the arm portions 40 is such that during use and entry intothe patient's oral cavity, the curvature of the arm portions 40 isdirected upward toward at least the ends of the arm portions 40.

The end effectors 12, 13, and particularly the arm portions 40, may berigid or may be bendable. If bendable, they should only be bendable tosuch a degree to allow the surgeon some amount of adjustability toaccommodate variations in patient anatomy. They should not be sobendable that they undergo bending during use by the surgeon.

The oval ring shape of the tip portions 42 of the end effectors 12, 13is enlarged relative to the arm portions 40 and assists in the removalof the adenoids. On one side of the ring shape, which is the inward,lower side seen in FIGS. 2 a-3, the tip portions 42 are provided withcutting portions 50, 51. The other side of the ring shape, the inwardupper side in FIGS. 2 a-3, griping portions 53 are provided, whichfunction as a mechanism by which the end effectors can grasp the tissuethat is being cut and cauterized. This grasping of the tissue by the endeffectors 12, 13 also efficiently allows for the removal of the cuttissue from the procedure site. While shown with an ovoid ring shape,the tip portions 42 of the end effectors 12, 13 may have alternativeshapes, such as a recti-linear, a curvi-linear or other shapes.

Like the arm portions, the length and width of the ovoid ring shapes ofthe tip portions 42 may vary. By varying the shape of the tip portions42, a variety of sized and shaped end effectors 12, 13 can be providedin kit form, allowing a surgeon to readily select, during the procedure,the end effector 12, 13 with a configuration that works best with aparticular patient's anatomy.

The end effectors 12, 13 do, however, differ in one regard.Specifically, one end effector 12 includes a conductive insert 44 thatextends through the arm and tip portions 40, 42 and operates as anelectrode for cautery purposes. In one embodiment, the other endeffector 13 may be formed with an insert 45 that is similar, but doesnot operate as the electrode. In another embodiment, the other endeffector 13 may be formed with a partial insert in the tip portion 42 orwithout any insert in the end effector 13. The insert 44 operating asthe electrode is best seen in the exploded view of FIG. 4. Hereafter,when referring to characteristics common to both inserts, the insertsare collectively referred to as “inserts”; and when referringcharacteristics relating to only the insert operating as an electrode,the insert is referred to as “insert/electrode.”

One end of the insert/electrode 44 defines an electrical contact 52 thatis ultimately coupled to the power source. In one embodiment, thecoupling of the electrical contact 52 to the power source is achievedduring the mounting of the end effector 12 on the mounting tip 34. Inthe instance where the lever member 24 serves as the conductor throughthe handle 22, the electrical contact 52 engages the mounting tip 34directly when the end effector 12 is mounted thereto. In an alternativeconstruction, the lever member 24 might not serve as the conductorthrough the handle 22. In such an instance, the conductor associatedwith the handle 22 may be in the form of a lead (see FIG. 6) embeddedwithin or mounted along the lever member 24, and terminating in aterminal. The electrical contact 52 would in that instance electricallyengage the terminal when the end effector 12 is mounted to the mountingtip 34.

Provided in the tip portions 42 of the end effectors 12, 13 are thecutting portions 50, 51 by which the adenoids are removed. The cuttingportions 50, 51 are oriented so that they generally oppose one another.In a preferred embodiment, the cutting portion 50 defined by theinsert/electrode 44 is conductive and further defines a blade. Thecutting portion 51 in the tip portion 42 of the other end effector 13 isnon-conductive and is defined by the body of the end effector 13 so asto form a bearing surface 55, such as an anvil, a pocket, a flat surfaceor free space, or as an insert in the body, shaped so as to correspondto the shape of the cutting portion 50. In an alternative embodiment,the cutting portion 51 of the other end effector 13 may also be providedas a blade, defined by an insert and be oriented with its edges alignedalong a common cutting plane, so that the edges of both cutting portions50, 51 abut one another when the handles 22 are brought together.Alternatively, the blades of the cutting portions 50, 51 may be slightlyoff-set relative to one another so as to be able to by-pass each inclose proximity and shear the tissue during tissue removal; or theblades of the cutting portions 50, 51 could abut one another at theiradjacent cutting edges, but be out of plane, so as to preventinadvertent contact by the with tissue near the surgical site. In oneadditional embodiment, the cutting portions 50, 51 could be providedsuch that they initially engage one another, but that with additionalforce, the slip or snap passed one another.

As shown in FIG. 3, the blade of the cutting portion 50 of theinsert/electrode 44 is preferably provided with a sharpened edge 54 thatinteracts with the correspondingly or congruently shaped bearing surface55 of the cutting portion 51 of the opposing end effector 13, or asharpened edge thereof, as mentioned above.

In the present embodiment, cutting and cautery of the adenoids areperformed by the same component, the cutting portion 50. To this end,adjacent to the blade and sharpened edge 54, the cutting portion 50 isprovided with a cautery blade portion 57. The cautery blade portion 57defines a width extending in a direction away from the sharpened edge54. Thus, immediately after tissue is dissected from the surgical siteby the sharpened edge 54, the cautery blade portion 57 is brought intocontact with the dissections site and the remaining tissue cauterized.

The cutting portions 50, 51 may also optionally be provided with anon-stick coating, or other technology, on their surfaces to preventadhesion and build-up of tissue on the surfaces of the cutting portions50, 51.

In the above described embodiments, cautery is effectuated by the samecomponent that performs cutting of the adenoid, namely the cuttingportion 50. The cautery and cutting functions could, however, beperformed by separate components. For example, cutting portion 50 of theinsert/electrode 44 may be replaced with separate cutting and cauteryblades (non-cutting) in the tip portion 42. The cautery blade, in thatinstance, would be coupled to the electrical contact 52 and the powersource. To sever the adenoids, the separate cutting blade would beprovided adjacent to the cautery blade, preferably at a locationradially inward on the ovoid ring shaped tip portion 42. Provided inthis manner, cautery would be performed as a separate function, butconcurrently with removal of the adenoids via the cutting blade.

The insert/electrode 44 of the end effector 12 is preferably insertmolded within rigid plastic or another material so that only the cuttingportion 50 and the electrical contact 52 are exposed. Insert molded inthis manner, inadvertent contact is minimized between theinsert/electrode 44 and any tissue that is not the subject of thesurgical procedure. As an alternative to insert molding, theinsert/electrode 44 could be inserted into previously formed arm and tipportions 40, 42 of the end effector 12.

The insert 45 of the other end effector 13, if provided with an insert,may similarly be insert molded within the end effector 13 orsubsequently inserted into the end effector 13 after molding thereof. Ifno insert is provided in the end effector 13, the inward side of the tipportion 42 is formed in the desired shape of the anvil or blade,depending on the particular configuration of the end effector 13 asdescribed above.

The end effectors 12, 13 are respectively engaged with and mounted tothe mounting tips 34, 36 of the lever members 24, 26. In order to mountthe end effectors 12, 13 to the handles 22 of the cautery forceps 10,mounting ends 46, 48 of the end effectors 12, 13, are formed so as tomatingly engage with the mounting tips 34, 36 of the handles 22. Thisengagement between the mounting tips 34, 36 of the handles 22 and themounting ends 44, 46 of the end effectors 12, 13 is preferably adetachable engagement. As such, the engagement may be a press-fit orsnap-fit engagement where a portion of the end effector 12, 13 isdisplaced as it passed over a corresponding portion of the mounting tips34, 36, and then resiliently snaps back into substantially it originalposition. Also, a twist/screw/threaded engagement, a keyed engagement, amagnetic engagement or a positive locking or latching construction canbe provided. In the illustrated construction of FIG. 2, a snap-fitengagement is provided wherein a portion of the mounting tips 34, 36 ismatingly received within a hollow portion of the mounting ends 44, 46.

Alternative Basic Constructions

Two alternative constructions of cautery forceps according to theprinciples of the present invention are shown in FIGS. 6 and 7. In FIG.6, a monopolar construction is shown wherein current is provided to theconductive end effector via an external lead. In FIG. 7, a bipolarconstruction is generally illustrated.

Referring to bipolar construction of FIG. 7, the cautery forceps 110have a construction is similar to that discussed above in connectionwith the embodiment of FIGS. 2 a-3. The bipolar construction differsfrom the unipolar construction in that both end effectors 112 areconductive and include electrodes for cautery purposes. As a result,each end effector 112 is therefore connected to the power source throughits respective the lever member 124, such as with a power cable 114having terminals 118 for connection to the handles 111 and a plug 116for connecting to a power source. While they may be the same, thecutting portions 150 of the end effectors 112 also do not need to beidentical. They may be appropriately varied as discussed above inconnection the end effectors 12, 13. Attention is therefore directed tothat section of this description.

In FIG. 6, the means by which the end effectors 212 are connected to thepower source is via an external, insulated electrical lead 260. Theinsulated lead 260 is connected to and supported along the length of thecautery forceps 210. Specifically, the lead 260 is directly connectedwith the end effectors 212 and does not utilize the lever members 224,226 of the cautery forceps 210 as a means to electrically couple thepower source to the end effectors 212. The lead 260 itself may form apower cable 214 that is connected to the power source, as illustrated,or may be joined with such a cable 214 at a plug connection.

In supporting the leads 260 on the cautery forceps 260, the leads of thecable may be extended through a series of retainers integrally formed onthe lever members 224, 226. The retainers may be of any desired shape,e.g. a rectangular shape, an annular ring shape or a C-shape. With aside opening, such as in a C-shaped retainer, the lead 260 may besnapped into the retainer as opposed to being threaded through anopening formed in an enclosed retainer. The retainers therefore may berigidly or resiliently formed and are sized to positively engage theexterior surface of a lead and retain it positioned therein. Theretainers themselves are not illustrated in FIG. 6.

When the cautery forceps 210 are constructed in the manner seen in FIG.6, the retainers are positioned so as to maintain the lead adjacent tothe lever member 224, in an unobtrusive manner, and along the length ofthe lever member 224. The lead may be position on either side (top andbottom) of the lever member 224

Alternatively, in a bipolar embodiment, each of the two leads may followthe length of its own lever member 224, 226 until engaging therespective end effector 212 mounted thereto. The two leads mayalternatively follow one lever member 224, 226 and connect to the endeffector 212 associated with the other lever member 224, 226, therebyavoiding the necessity of having the leads 260 cross over one another inthe region of the pivot joint 228. In any of the alternativeconstructions, the retainers 262 should prevent the leads 260 fromloosely hanging and should minimize potential interfere by the leads 260with the surgeon during the surgical procedure.

As an alternative to the scissor-like construction described in theprevious embodiments, it should be apparent that the handles could beprovided with a tweezers-type construction (a construction where thehandles are generally U-shaped or V-shaped and gripped in front of thepivot connection of the lever members and behind the end effectors). Thevarious features of the above discussed embodiments, individually orcollectively, could accordingly be applied to the tweezers-typeembodiment, or any of the embodiments discussed herein. As a furtherembodiment, the construction of the cautery forceps could be such thatthe end effectors are provided as a set of jaws on one end of a shaft,tube or hand piece and operated via manipulation of a trigger mechanismon the other end, as in an endoscope type construction or a pistol griptype of construction.

With all of the above described constructions, the cautery forceps 10,110, 210 incorporate a reusable handle, after appropriate sterilization.The end effectors themselves may be of a disposable nature or maybeconstructed so as to allow for sterilization and reuse. Additionally,the end effectors may be provided, in a variety of sizes and curvaturesso as to facilitate their use with different patients and to accommodatea range of different anatomical variations in those patients. As such,the end effectors may be offered individually, either with or withoutthe handles, or maybe offered in a kit format whereby a set of differentend effectors, are provided either with or without the handles.

Seen in FIGS. 8 and 9 is an additional construction of cautery forceps310 embodying the principles of the present invention. The cauteryforceps 310 of this embodiment are unipolar in their construction, likesome of the earlier described embodiments, but do not include detachableend effectors. Rather, the end effectors 312, 313 are non-detachablyformed with handles 311 and lever members 324, 326 of the forceps 310.Constructed in this manner, the entire cautery forceps 310 may be of adisposable nature or of a reusable nature, after sterilization,depending on their specific construction.

Like the prior embodiment, the handles 313 of the cautery forceps 310operate with the two lever members 324, 326 in a traditional,scissors-like construction. The two lever members 324, 326 cross oneanother at a central pivot joint 328 defined by a pivot axle 329 Eachhandle 311 includes a finger grip 330, 332 in the form of a ring. Bybringing the finger grips 330, 332 together, the end effectors 312, 313are likewise brought toward one another enabling them to grasp thedesired tissue of the patient.

The handles 311, lever members 324, 326 and end effectors 312, 314 areformed by overmolding underlying, rigid frame members 325, 327, whichare seen in FIG. 9. The frame members 325, 327 themselves can beconstructed of a variety of materials, so long as they impart sufficientstrength to the cautery forceps 310 for the surgical procedure to beperformed. As such, the materials for the frame members 325, 327 can bea metal material, such as surgical stainless steel, aluminum or anothermaterial formed by stamping, cutting, grinding, casting or forging.However, at least one frame member, hereafter the active frame member325, is constructed from an electrically conductive material so as to beable to transmit electric current through the cautery forceps 310, asfurther discussed below.

The pivot joint 328 between the frame members 325, 327 is constructedsuch that it electrically isolates the frame members 325, 327 from oneanother, particularly if both frame members 325, 327 are formed ofmetal, and the joint may utilize an insulating bushing.

The overmolding of the frame members 325, 327 electrically isolatesthem, and in particular the active frame member 325, from the surgeon.While various techniques may be employed to form the overmold, includingthose discussed above, it is preferred that overmold is formed byinsert/injection molding. The exterior surface of the overmold can betextured or smooth, but should facilitate grasping of the handles 311and finger grips 330, 332, thereby reducing the potential for thecautery forceps 310 to slip in the grasp of the surgeon.

In this embodiment, and alternatively in the prior embodiments, thepower cable 314, which is a single strand standard coated RF surgicalcable, is permanently attached to one end of the active frame member 325by soldering, prior to overmolding. The opposing end of the cable 314includes an accessory plug 316 or a standard three prong surgical plug.

The end effectors 312, 313 have the same general construction andattributes mentioned above, the discussion of which is incorporated byreference, other than being removable, and are principally composed ofan arm portions 340 and a tip portion 342, 343, with the latter beingformed at the distal end of the arm portions 340. Likewise as previouslydiscussed, the arm portions 340 may be bendable to allow adjustment bythe surgeon to accommodate variations in patient anatomy.

As with the prior embodiments, the tip portions 342, 343 are illustratedas having an oval, ring shape to assists in the removal of the adenoids.On the inward and lower side of one of the tip portions 342 is a cuttingportion 350. The cutting portion 350 is integrally, and preferablyunitarily, formed as an end part of the active frame member 325 and isnot fully over molded like other portions of the frame member 325. Assuch, the cutting portion 350 form an exposed portion of the activeframe member 325 and operates as the conductive electrode of the cauteryforceps 310. The cutting portion 350 may therefore include a cuttingblade with a sharpened edge, optionally provided with a non-stickcoating, and a cautery blade having an exposed width for cauterypurposes.

The opposing tip portion 343 preferably does not include a cuttingportion integrally formed with the frame member 327. Rather, the cuttingportion 351 of this tip portion 343 opposes the cutting portion 350 ofthe active frame member 325 and is preferably formed and defined by thematerial of the overmold. The cutting portion 351 may define a bearingsurface opposing the cutting portion 350 or an edge/blade interactingwith the cutting portion 350, as discussed in connection with any of theprior embodiments.

As with the prior embodiments, the upper side of ring shape of the tipportions 342, 343 operate as a mechanism by which the end effectors 312,314 can grasp the tissue that is being cut, cauterized and removed fromthe procedure site. While again shown with an ovoid ring shape, the tipportions 342, 343 of the end effectors 312, 313 may have alternativeshapes, lengths and widths.

Method of Use

When using the unipolar variations of the cautery forceps, electricalcurrent is delivered to the end effector having the insert/electrode.The cutting portions on the end effectors are then brought to bearagainst the adenoid tissue that is to be excised. As the adenoid tissueis being removed, current flows from the cutting portion of theinsert/electrode, through the adenoid tissue, and out of the patient'sbody at another electrode that has been attached in a remote locationapart from the adenoid tissue. With this passage of current,radio-frequency energy is applied to tissue, heating the water in thelocal tissues. The heating of the water inherent in the tissue resultsin a weakening and/or severing of the tissue, allowing mechanicalremoval and simultaneous cauterizing of removal site.

In the bipolar constructions, the return path for the electric currentis defined by the opposing end effector when it is brought near theother end effector. The electrical current will travel through thesubject tissue from one end effector to the other. Accordingly, duringthe cutting and removal of the adenoid tissue, the cutting portions ofthe end effectors not effectuate removal of the subject tissue, but alsocauterizing of the tissue removal site.

To electrically actuate the end effectors of any of the embodiments, aswitch may be provided in-line with the power cable. The switch may bein the form of a hand or foot operated switch, or it may be provided aspart of the power source. In a further embodiment, the end effectorsmight be automatically energized when brought into close proximity ofone another and therefore not require manipulation of a switch per se.This automatic energizing could be achieved via proximity sensors orlimit switches provided as part of the cautery forceps or simply bycompleting the conductive circuit through the tissue.

As a person skilled in the art will readily appreciate, the abovedescription is meant as an illustration of implementation of theprinciples this invention. This description is not intended to limit thescope or application of this invention in that the invention issusceptible to modification, variation and change, without departingfrom spirit of this invention, as defined in the following claims.

1. A method of removing tissue from a patient utilizing anelectrosurgical instrument, the method comprising: providing anelectrosurgical instrument having a pair of opposing end effectors, atleast one of the end effectors including a conductive cutting portionand the other of the end effectors including an opposing portion, theend effectors each further including opposing tissue retention portions;positioning the conductive cutting portion on one side of the tissue tobe removed and positioning the opposing portion on an opposing side ofthe tissue to be removed; positioning the tissue retention portions ofeach end effector on opposing sides of the tissue to be removed; causingrelative movement of the end effectors toward each other; constrainingthe tissue to be removed between the tissue retention portions;providing electrosurgical energy to the conductive cutting portion;discharging electrosurgical energy to the tissue; dissecting the tissuethrough a combination of the electrosurgical energy discharged to thetissue and the conducting cutting portion; cauterizing the tissuethrough the electrosurgical energy discharged to the tissue; performingthe dissecting and cauterizing steps while constraining the tissuebetween the tissue retention portions; and removing the dissected tissuefrom the patient while constraining the tissue between the tissueretention portions.
 2. The method of claim 1, wherein the step ofdissecting the tissue utilizes a sharpened edge formed on the conductingcutting portion.
 3. The method of claim 1, wherein the step ofcauterizing the tissue utilizes a width of the conductive cuttingportion facing in a direction away from the direction of movement. 4.The method of claim 1, further comprising the step of contacting anelectrode with the patient at a location remote from the site of thetissue to be removed.
 5. The method of claim 1, wherein the positioningstep positions at least a portion of the tonsil tissue between the endeffectors.
 6. The method of claim 1, where the tonsil tissue ispharyngeal tonsil tissue.
 7. A method of removing tonsil tissue from apatient, the method comprising: providing an electrosurgical instrumenthaving a pair of opposing end effectors, at least one of the endeffectors including a conductive cutting portion; engaging a portion ofthe tonsil tissue between the conductive cutting portion and the otherend effector; providing electrosurgical energy to the conductive cuttingportion; discharging electrosurgical energy through the conductivecutting portion; dissecting the portion of the tonsil tissue through acombination of the electrosurgical energy and the conducting cuttingportion; cauterizing the tissue; and removing the portion of dissectedtonsil tissue from the patient with the electrosurgical instrument. 8.The method of removing tonsil tissue from a patient as set out in claim7, wherein the tonsil tissue is pharyngeal tonsil tissue.
 9. The methodof removing tonsil tissue from a patient as set out in claim 7, whereinthe positioning step locates the conducting cutting portion on one sideof the tonsil tissue and the other end effector on an opposing side ofthe tonsil tissue.
 10. The method of removing tonsil tissue from apatient as set out in claim 7, further comprising the step of moving theend effectors toward one another during the dissecting step.
 11. Themethod of removing tonsil tissue from a patient as set out in claim 7,further comprising the step of bending the end effectors to accommodatevariations in patient anatomy.
 12. The method of removing tonsil tissuefrom a patient as set out in claim 7, wherein the removing step removesthe portion of dissected tonsil tissue by grasping the portion ofdissected tonsil tissue between the end effectors.
 13. The method ofremoving tonsil tissue from a patient as set out in claim 7, wherein thedissecting step further includes the step of moving part of the other ofthe end effectors past the conductive cutting portion.
 14. The method ofremoving tonsil tissue from a patient as set out in claim 7, wherein theelectrosurgical instrument is operated in a scissors manner.
 15. Themethod of removing tonsil tissue from a patient as set out in claim 7,wherein the steps of dissecting and cauterizing are both performed bythe discharging of electrosurgical energy through the conductive cuttingportion.
 16. The method of removing tonsil tissue from a patient as setout in claim 7, further comprising the step of affixing a returnelectrode to the patient.
 17. The method of removing tonsil tissue froma patient as set out in claim 7, wherein the electrosurgical instrumentincludes a pair of handles, and further comprising the step of movingthe handles toward one another during the discharging of theelectrosurgical energy.
 18. The method of removing tonsil tissue from apatient as set out in claim 7, further comprising the step of discardingthe electrosurgical instrument after the removing step.
 19. The methodof removing tonsil tissue from a patient as set out in claim 7, furthercomprising the step of performing the dissecting and cauterizing stepswhile the tonsil tissue is located between the end effectors.
 20. Themethod of removing tonsil tissue from a patient as set out in claim 7,further comprising the step of positioning the conductive cuttingportion of the one end effector on one side of the tonsil tissue andpositioning the other end effector on an opposing side of the tonsiltissue;